Nurse Shajaira Powell-Bailey measures out a vaccination at a Florida elementary school. Vaccines, not as effective this year against circulating strains, are still the best defense, the state health department and CDC say.

The cost common flu strain this year in Colorado is influenza A, or H3N2 virus, which is a severe one.

It is known to lead to more hospitalizations and deaths than other strains, according to the state health department, especially among the elderly, young children and people with certain chronic medical conditions.

“We tend to have more severe seasons when H3N2 viruses predominate,” Dr. Lisa Miller, state epidemiologist at the Colorado Department of Public Health and Environment said in a recent release.

Reported influenza hospitalizations and outbreaks in long-term care facilities in Colorado increased in early December. There were 24 outbreaks by Dec. 6.

The health department said the best defense in getting a flu vaccine. Even though, this this year, it won’t be as effective. About half of the H3N2 viruses circulating are different from those included in this season’s vaccine, the Centers for Disease Control and Prevention reported. Viruses change and present a moving target for virologists.

Besides getting a flu shot, the health department says, cover coughs and sneezes, stay away from sick people and wash hands often. “If you’re sick, stay home from work or school so you don’t spread the virus to others,” the health department advises.

For the week ending December 6, influenza activity continued to increase. State
laboratory surveillance shows that almost all influenza viruses currently circulating in Colorado are the H3N2 virus, the health department reports.

There were 153 additional hospitalizations reported during the most recent week for which data are available (compared to 57 the previous week ending Nov. 29). Of these reported cases, 51 were from the previous week and 102 were new.

The state’s cumulative total is 248 hospitalizations in 23 counties.

Update: An influenza-associated death of a child was confirmed in Larimer County Monday, Dec. 16. An 18-month-old Loveland girl died from the flu at McKee Medical Center Dec. 9.

CDPHE surveillance for the 2014 –2015 influenza season officially began on September 28 and will run through May 23. Current surveillance activities include: reporting of hospitalizations due to influenza, reporting of influenza-like illness
visits by selected sites, reporting of influenza testing activity by sentinel hospital labs, monitoring circulating influenza viruses through molecular typing at the state public health laboratory, outbreaks of influenza in long-term care facilities (LTCF), and reporting of pediatric deaths due to influenza.

This undated photo provided by Arapahoe Basin Ski Area in Colorado shows a group of children practicing their ski moves with an instructor.(AP Photo/Arapahoe Basin Ski Area, Dave Camara)

Colorado is the eighth healthiest state, according to United Health Foundation’s annual health rankings, released Dec. 10.

The index ranks Colorado as the least obese state, and No. 1 both in physical activity and low diabetes prevalence.

Colorado ranked second in having the lowest rate of cardiovascular deaths and ranked third lowest in cancer deaths.

Still, it loses out to seven other states, in this order: Healthiest Hawaii, Vermont, Massachusetts, Connecticut, Utah, Minnesota and New Hampshire.

The three main factors dragging down our ranking: prevalence of binge drinking, low birth weights and the large disparity in health status between highly educated and less educated Coloradans.

Gov. John Hickenlooper said in a press release, “As Coloradans, we know this state is a lean, mean, working-hard, playing-hard healthy machine. Well, not mean, but you get the idea. I’m not surprised we’re the least obese state and No. 1 in physical activity. Now, let’s keep the body moving and become the healthiest state.”

Dr. Larry Wolk, chief medical officer at the Colorado Department of Public Health and Environment, said: “Many factors contribute to having a healthy state, from our vibrant economy and people who value outdoor recreation, to the contributions of many state and local public health partners that focus on keeping Coloradans healthy.”

“With a low prevalence of chronic diseases, such as obesity and heart disease, we are able to focus our attention on prevention. The result will be spending less money on health care while improving our quality of life and longevity. Colorado should be proud of its culture of promoting good health,” said Chris Wiant, chief executive of the Caring for Colorado Foundation.

“One area where we hope to see significant improvement is in lowering Colorado’s rate of whooping cough. In the past year we saw a 256 percent increase in whooping cough, or pertussis, cases, ” Dr. Wolk said.

In October 2012, the state health department declared a pertussis outbreak when Colorado surpassed 1,000 cases. As of Nov. 15 this year, the state has 1,161 pertussis cases, despite vaccination being an effective tool against pertussis.

The Colorado Consumer Health Initiative Wednesday launched a new website,“Covered U,” to help the newly insured navigate how and where to find health care services.

CoveredU.org is a tool that community-based health groups and Connect for Health Colorado guides could use to help educate health care consumers on buying and using health insurance, CCHI says.

“Now that Coloradans can sign up for health insurance again under open enrollment, it’s important that they not only know how to buy the best plan for their health care needs, but also know how to use that insurance,” Adam Fox, CCHI director of strategic engagement, said in a press release. “The interactive website will allow consumers to compare their health care choices and costs in basic scenarios and identify what kind of coverage might best suite them.”

Users can either select either “How to USE your health insurance” or “How to SHOP for health insurance.” The section on using insurance offers “choose your own adventure” style medical scenarios, such as sick, cut or appendicitis, and shows options for provider locations, such as doctor’s office, urgent care center or emergency room. It gives a cost estimate for each choice.

“The big news is that almost everyone will be able to get health insurance through Connect for Health Colorado,” said CCHI’s Fox. “But a big part of health insurance is how and where somebody accesses care. Now it’s easy to get the guidance they need to use their health insurance most appropriately and most affordably.”

A Nov. 11 survey by the Kaiser Family Foundation found many Americans with less education, younger people and the uninsured do not understand how to most effectively use health insurance.

Ernie Applegate holds his new grandson, Moses Beau Jackson, soon after suffering a massive heart attack and being saved by a Delta flight crew he was driving from the airport.

It just goes to show you that you really are more likely to die in a car accident than a plane crash, Delta flight attendant Princeton Richardson writes.

But thanks to a well-trained flight crew no one died when a van driver carrying six passengers to a Denver hotel suffered a massive heart attack en route.

After a long morning that had begun at 4:40 a.m. Oct. 29, the crew was eager for its layover in Denver. Between texting and napping, they didn’t pay too much attention, beyond wondering if there was car trouble, when driver Ernie Applegate briefly pulled over to the side of the road — twice. Then he pulled back onto the road.

Applegate slumped over in his seat, unconscious, as the van kept speeding along a steep embankment on a congested expressway near Denver International Airport, Richardson said.

Banks jumped from her seat behind the driver to grab the wheel.

“I was just scared because as soon as one of the pilots yelled to grab the wheel, I was on it and determined to keep us in a lane and not to let go,” Banks said.

Richardson dived for the floor and held down the brake with his hand. He stopped the van.

Everyone got out. The crew’s captain, Patrick Working, and another flight attendant, Crystal Wright, pulled Applegate out of the van and away from traffic. Co-pilot Mark Nowlin flagged traffic, called 9-11 and tried to hail passing emergency vehicles to see if a defibrillator could be found.

Working, Richardson, Banks and Wright rotated performing chest compressions on Applegate until a fire station crew arrived. They estimate it took 15 to 20 minutes until these paramedics came and took over — with a defibrillator.

“I was out. I was dead. I was finished,” Applegate said. “They saved my life. All of them.”

Applegate said he regrets the mistakes he made — trying to shake off fatigue, shortness of breath and chest pain, telling himself he could call in sick after he delivered the crew to the hotel.

Paramedics took Applegate to the University of Colorado Hospital, where doctors placed a stent to restore blood flow to his heart.

Delta crew members visited the hospital later that night after they heard Applegate was stable. They held the hands of his wife, daughter and son — and they prayed with them.

“The only reason I’m here is because they kept giving me CPR all that time,” Applegate said.

Later that same night, Applegate’s daughter gave birth to his second grandson in another hospital. Applegate was soon able to hold Moses Beau Jackson.

“I’m glad it wasn’t out with the old, in with the new,” Applegate said, laughing. “It was a joyous moment. I’m glad I’m here to build memories with him.

This combination photo made from file images provided by the U.S. Food and Drug Administration shows two of nine cigarette warning labels from the FDA. A judge blocked the federal requirement that would have begun forcing U.S. tobacco companies to put large graphic images on their cigarette packages in 2012 to show the dangers of smoking and encouraging smokers to quit lighting up. (AP Photo/U.S. Food and Drug Administration, File)

The Centers for Medicare and Medicaid Services this week announced a proposal to cover an annual low-dose CT scan for Medicare beneficiaries at high risk for developing lung cancer.

Medicare defines high-risk individuals as those 55 to 74 years of age with a smoking history of 30 pack years — either a pack a day for 30 years or 2 packs a day for 15 years and so on — and who are current smokers or have quit smoking less than 15 years ago.

Under the Affordable Care Act, effective preventive measures –as determined by the U.S. Preventive Services Task Force — are included in the “essential health benefit” and are covered beginning Jan. 1 for those individuals who meet the screening criteria and are enrolled in state health marketplace plans, Medicaid-expansion programs and new private insurance plans.

Lung cancer causes 30 percent of all cancer deaths in America. It kills 150,000 people a year. The survival rate for lung cancer is lower than for any other common cancers, such as breast, colon and prostate.

“Studies have clearly shown that individuals at high risk for lung cancer should receive this low-dose CT scan every year because it can help catch lung cancer in the earliest stages,” said Dr. Peter Sachs, associate professor of radiology at the University of Colorado Hospital.

The hospital is now offering screening for early-stage lung cancer to high-risk patients referred by their physicians who have no personal history of lung cancer.

Jennifer Perkins, second from left, a broker from The Jen Perkins Agency, and Rachel Gips, second from right, a guide from the GLBT Community Center of Colorado, try to help customers as they figure out their options for health insurance. In the final week leading up to the March 31, 2014, deadline for signing up for health insurance through the Affordable Care Act. (Kathryn Scott Osler The Denver Post)

Connect for Health Colorado, the state health insurance marketplace, is touting its new and improved enrollment website for customers shopping for private health insurance.

Open enrollment under the Affordable Care Act begins Nov. 15 and runs through Feb. 15, 2015.

More than 148,000 individuals are covered through plans purchased on the Marketplace in 2014.

All this week, customers could compare policies offered in their area, research eligibility for tax credits, choose coverage and begin the enrollment process.

“We want to encourage consumers to comparison shop for policies that meet their needs and their own particular circumstances,” said interim CEO Gary Drews. “Monthly premiums, benefits and the financial assistance available to consumers who qualify can change each year. This year, there are some new, less expensive choices available in many regions. We are urging Coloradans to be smart consumers – and compare their options before renewing their current plan or enrolling in a new one.”

Applicants this year can use a single application process directing consumers to either complete enrollment in private health insurance through Connect for Health Colorado or with Medicaid with the state Department of Health Care Policy and Financing.

During open enrollment, other new features will roll out as ready including:

An Avatar/Guide named “Kyla,” a virtual assistant who can help customers through some key steps of the enrollment process.

A Medication Look-Up Tool, or formulary, which lets customers compare prescription coverage under various policies.

A Provider Directory to help customers check whether their doctor is in the network of a health plan.

Whether renewing or enrolling for the first time, exchange customers must complete enrollment by Dec. 15 to have coverage Jan. 1, 2015, and avoid a gap in insurance.

Sergio Rodriguez clears snow from sidewalks in downtown Denver, November 12, 2014. A storm has moved into the are bring cold temperatures and snow. (Photo by RJ Sangosti/The Denver Post)

Frostbitten fingers and toes are being saved by a drug long used to treat heart attack, pulmonary embolism and stroke.

About the time Coloradans were heading off to work and school Wednesday morning it was 1 degree outside in the metro area and the Thursday morning forecast was for subzero temperatures.

When the mercury falls below five degrees, even with light winds, prolonged exposure to the cold, or touching frozen metal or ice, causes skin and sometimes underlying tissues to freeze and crystallize.

But if frozen tissues are treated within 24 to 48 hours, this drug therapy adapted to treat frostbite is proving to reduce long-term effects and the risk of amputation.

The drug, tissue plasminogen activator, or tPA, is a protein that catalyzes the breakdown of blood clots.

“We would use it for anybody who had even part of a finger or foot that’s compromised,” said Dr. Gordon Lindberg, medical director of the University of Colorado Hospital’s burn center.
“Whenever we get a cold snap like this, many people are caught off guard,” Lindberg said. “Tissues get frozen. It damages the surface of the blood vessels and they form clots. We thaw the tissues out. If we see no improvement in the tissue or restoration of pulses we initiate the tPA protocol.”

The drug is given intravenously over several hours in the burn center intensive-care unit with patients closely monitored because the drug can cause bleeding.

Linda Staubli is a clinical nurse educator who helped develop the protocol, which is seeing increasing use here and adoption around the country.

She said 19 patients were hospitalized here for frostbite in 2013. Four received tPA, and none of their 35 affected digits had to be amputated.

The 15 people who didn’t receive tPA lost a collective 23 fingers or toes, she said.

January through March 2014, 14 people were hospitalized for frostbite. Three received tPA. Of 22 affected digits, only one was lost.

Overall, Staubli said, 21 percent of frostbitten digits are amputated at the burn center when tPA isn’t used. Fewer than 2 percent are lost when it is.

With wind chill below 16.6 degrees, exposed skin can get frostbitten in less than 30 minutes. First a person’s skin is cold and red, a prickly or tingling feeling, burning, then numbness. Skin grows hard, pale and waxy, Lindberg said. Joints and muscles get stiff and clumsy.

Fingers, toes, noses, ears, cheeks and chins are the most commonly frostbitten areas, Gloves and other coverings help, but are no guarantee.

It’s an age-old problem that’s actually become more prevalent outside military service in the decades since the 1950s because of the popularity of winter sports and mountaineering. High-altitude frostbite – cold combined with low-oxygen levels in the blood and dehydration — has an even worse prognosis.

The worst thing is repeated freeze-thaw cycles, Staubli said. It’s better to keep extremities cold until they can be warmed up for good, rather than going inside, warming up and returning outside to refreeze. They’re not sure why, she said.

According to the Mayo Clinic online guide, people at greater risk of frostbite include babies, old people, diabetics, smokers, those previously affected by frostbite and those who abuse drug or alcohol.

Long-term effects or complications of milder frostbite include increased sensitivity to cold, lasting numbness and increased vulnerability to frostbite. More serious cases can result in nerve damage, infection, increased risk of tetanus, gangrene and amputation. Other lasting complications include frostbite arthritis and growth defects in children whose growth plates were damaged.

Frostnip can be treated at home. Serious cases should be seen by a physician. For example, serious cases involve blistering of skin after it’s been rewarmed.

At home or at the doctor’s, the first treatment, according to Mayo Clinic guidelines, is rewarming skin in a warm, not hot, water bath for 15 to 30 minutes, and then gentle movements of affected areas. It hurts, and oral pain medicine is indicated.

Once thawed, skin should be loosely wrapped in sterile sheets, towels or other dressings to protect it. Affected areas might need to be elevated to reduce inflammation.
If bone or muscle is affected, the doctor or nurse might apply a splint.

Any dead tissue is removed, sometimes three months after the injury.

Sometimes whirlpool therapy and antibiotics are prescribed.
Another new therapy undergoing study is hyperbaric oxygen therapy, which is breathing pure oxygen in a pressurized room. In early studies, some patients saw their symptoms lessened.

Huga Goto, at 2, looks at all the costumes while trick-or-treating last year during the Munchkin Masquerade on the Pearl Street Mall in Boulder. (Jeremy Papasso / Boulder Daily Camera)

The most common chronic disease of early childhood is tooth decay — five times more common than asthma.

Despite being largely preventable, tooth decay continues to plague children, especially those in lower-income families, even more in this last decade than before. At least 4 million U.S. preschoolers suffer with it.

In Colorado, 40 percent of kindergartners have had cavities, according to a 2012 report of the Colorado Department of Public Health and Environment.

So before your children head off to fill bags, buckets, pillow cases and totes with sugar-laden substances, here are some things to consider.

Wanjek says that candy isn’t the worst thing for your teeth. The most harmful factors are stickiness and acidity, so potato chips and fruit chews or leathers are actually worse than chocolate. Among candies, sour gummies are the worst for teeth, he says.

Pediatric dentist Dr. Elizabeth Shick with the CU School of Dental Medicine at the Anschutz Medical Campus agrees sticky or sour candies, or hard candies that stay in the mouth a long time, are the worst for teeth.

Besides the obvious recommendation — always brush before bedtime — Schick says set aside a special treat time each day so that children have a limited exposure instead of all-day candy eating. Consider having treat time shortly after mealtimes, she says, because saliva production increases during meals and helps neutralize bacteria production in the mouth and rinse away food particles.

Some things to consider year-round:

Even baby teeth cavities need to be filled, according to ChildrensDentalHealth.com. Untreated cavities can lead to pain, abscesses, spreading infection and long-term dental sensitivity. Baby or primary teeth that are healthy and present help with proper chewing and nutrition, speech development and they serve as better guides for erupting permanent teeth, the site says.

Really? Little tiny caries in teeth that are going to fall out anyway. Kids have to have all those filled? They do, according to Professor William Bailey with the University of Colorado School of Dental Medicine, who is he Delta Dental Endowed Chair in Early Childhood Caries Prevention.

“It’s important to get them fixed. They (caries) are easy to fix when they’re small,” Bailey said. Otherwise, if tooth decay really takes over, it could require later oral surgery. And early decay in children is the leading predictor of future decay.

Oral health is so important, Bailey said, that pediatricians and primary care physicians are all checking on it during the first well-child visit, which should happen by age 1.

The Affordable Care Act expanded dental coverage, and among the services that must now be covered at no cost by all health plans are: oral-health risk assessments by a pediatrician and application of fluoride varnish for children through age 5, which Bailey also recommends.

The act also gives state Medicaid programs the option of receiving a 1 percent increase in federal matching funds if states provide all the ACA services at no cost to patients. Colorado is one of 10 states that had chosen this option as of September.

Heather Carson, an emergency room nurse at Henry Mayo Hospital in Valencia, wears stickers with names of the two Texas nurses infected with the Ebola virus, after she and other members of the California Nurses Association and National Nurses United met with Gov. Jerry Brown to discuss the Ebola crisis, Tuesday, Oct. 21, 2014, in Sacramento, Calif. The Nurses unions, which have highly critical of the response so far, say they want California to be the national leader in enacting the highest Ebola safety standards. (AP Photo/Rich Pedroncelli)

The Denver Post heard from several Kaiser Permanente patients this week who were taken aback to be asked about Ebola, when calling to schedule a wellness visit, mammogram or other routine exam or procedure. They were asked if they had traveled to an Ebola-affected area or been in contact with any suspected Ebola patients.

The Colorado Department of Public Health and Environment recently launched its “Ebolas: Facts, not fear,” campaign. Was the Ebola questioning of every Kaiser patient, not just those with flu-like or Ebola-like fevers or symptoms, overkill or reasonable? We asked the health department.

It turns out a better slogan might be, “Better safe than sorry.”

CDPHE chief medical officer Dr. Larry Wolk said: “We appreciate efforts of all health care providers to help keep Coloradans safe by asking patients about their travel history and symptoms.”

The CDPHE’s guidelines for health-care providers can be summarized as “Ask! Isolate. Call us.”

“Ask (apparently everybody) about travel to Sierra Leone, Guinea and Liberia in West Africa in the past 21 days.”

“If travel or exposure criteria are met, and the person has symptoms of Ebola, place the person in a private room.” Close the door. And use the Centers for Disease Control and Prevention’s rigorous revised guidelines for personal protective equipment — no skin exposed.

Call us: Notify the hospital’s leaders and call the CDPHE, 303-692-2700, or after hours, 303-370-9395. State health officials will notify the CDC, if warranted.

A sign placed out on the 16th Street Mall beckoned people in late March to sign up for health insurance through the Affordable Care and Connect for Health Colorado. (Kathryn Scott Osler, The Denver Post)

Colorado was one of 16 states that set up its own health insurance exchange under the Affordable Care Act and one of 27 states to expand Medicaid.

Between the two, Colorado had enrolled more than 300,000 in one or the other by March 31.

Among the state exchanges, Colorado had the fourth-highest number of people sign up for private insurance through its marketplace, Connect for Health Colorado. That was estimated to be 25 percent of eligible individuals.

The Colorado Health Foundation hired the RAND Corporation to study why the rest hadn’t signed up. The foundation released the report, “Barriers to Enrollment in Health Coverage in Colorado,” in mid-October.

To identify the barriers to enrollment, researchers talked to more than 100 uninsured and newly insured and also interviewed people involved in insurance policy and the enrollment process.

They found consumers were confused about Medicaid and the subsidies available through the exchange for private insurance. When messages weren’t confusing, they weren’t particularly compelling. RAND concluded more of the messaging should focus on the benefits of getting insurance rather than the penalties of ignoring the mandate.

The study showed some people disliked or resented the mandate to have insurance and/or mistrusted the system.

RAND also found that not enough resources were expended to support local outreach, to clear things up and to make it easy for the uninsured to take action.

“It is not enough to say ‘see your local assistance site for more information,’ the report said. Instead, messaging should provide local names, locations, and contact information.

Others still considered health insurance unaffordable and were “wary of signing up for something that was going to cost them unspecified amounts of money in the future.”

Electa Draper is the health writer for The Denver Post and has covered every news beat in a 22-year journalism career at three newspapers. She has a bachelor's degree in biology and a master's in journalism.